Meal Plan Form
Welcome to your journey! Before we get started we will have you fill out this questionnaire. As your coaches we want to make sure that we learn as much about you and your goals as possible so we can create your meal plan! Meal plans will be delivered 5 days prior to the beginning of each month via email. Please make sure to fill out this form as soon as you sign up! If you have any questions prior to beginning contact us directly via email Ketogirlies@gmail.com. XOXO ❤️
Name
First Name
Last Name
What email would you like to receive your meal plan to?
example@example.com
Are you Male or Female/
Female
Male
How old are you?
-
Month
-
Day
Year
Date
What are your goals/intentions during this journey?
Are you familiar with the Keto Diet?
Yes
No
Why do you feel like you haven’t been able to make this change and lose weight on your own?
What is your body fat percentage? * If you aren’t sure just guess!
20%-25%
25%-30%
30%-35%
35% or higher
What is your current weight? (If you aren’t sure, just guess)
What is your goal weight?
How active are you on a daily basis?
Not active (not active at all)
Lightly active (1-2 walks or workouts a week)
Active (3-5 workouts a week)
Very Active (4-6 days of 30 min+ workouts a week)
I am interested in a personal workout routine weekly
How many calories do you consume daily? If you’re not sure just guess!
How tall are you?
Do you have any food allergies? If so please list them below.
If you struggle with any health conditions, eating disorders, or diseases please explain.
Are you currently breastfeeding?
Yes
No
Would you like me to include coffee in your meal plan?
Yes
No
Is there any foods you strongly dislike?
What are your biggest cravings?
What’s your Instagram or TikTok? (If you have one!)
How did you hear about Keto Girlies?
Instagram
Tiktok
Friend referral
Other
Are you comfortable with being added to a community group chat?
Yes
No
Submit
Should be Empty: